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Duodenal Switch vs. Gastric Sleeve

Once it is found that you qualify for bariatric surgery, you and your doctor are going to need to determine the weight loss procedure that makes the most sense for your health, BMI, budget, and commitment to weight loss. One of the most common options used by bariatric surgeons today is known as the gastric sleeve, or the “vertical sleeve gastrectomy.”

Yet despite the success of gastric sleeve there is another related surgery, known as the duodenal switch, that may support greater weight loss in patients. But how do gastric sleeve and duodenal switch compare? We explore the two options in this article.

Summary of Both Surgeries

Duodenal Switch – Also known as the Biliopancreatic Diversion, the duodenal switch involves removal of a large portion of the stomach, along with a rerouting of the lower intestine so that food moves through the lower intestine quickly and with less time to absorb calories.

Gastric Sleeve – Also known as the vertical sleeve gastrectomy, gastric sleeve surgery also involves the removal of a large portion of the stomach, but does not require the rerouting of the intestine. The stomach removal also inhibits production of ghrelin, the hunger hormone.

Duodenal Switch and Gastric Sleeve: A Shared History

Duodenal switch and gastric sleeve have some similarities because the gastric sleeve actually began from a modification of the duodenal switch. The duodenal switch involves both a restrictive component (the stomach removal, which prevents overeating) as well as a malabsorption component (the rerouting of the small intestine, which reduces time in the stomach so your body can’t process all of the calories).

However, researchers and bariatric surgeons eventually started studying whether or not the restrictive component alone could promote weight loss. After several years of study, they found that for many, the restrictive component alone was enough, and so they turned it into its own bariatric surgery, known as the “Vertical Sleeve Gastrectomy,” or “Gastric Sleeve.”

That means gastric sleeve is, in many ways, simply a less extreme version of the duodenal switch.

Differences Between Duodenal Switch and Gastric Sleeve

There are very few differences between the restrictive component of the duodenal switch and the vertical sleeve gastrectomy. Most of the differences between the two procedures is related to the rerouting of the small intestine. However, this difference is significant, with both advantages and disadvantages. Differences include:

Weight Loss – By adding the malabsorption component, the duodenal switch is able to support more weight loss than gastric sleeve. Research has shown that the average duodenal switch patient will lose as much as 70% of their excess weight, on average, while gastric sleeve excess weight loss averages around 60% – good, but not to the degree of duodenal switch.

Complications – The rerouting of the small intestine introduces a number of potential complications. Not only is the surgery more complicated for the surgeon (which could lead to surgical complications) but the new digestive tract can lead to increased flatulence, bloating, and diarrhea. These are far less common with gastric sleeve.

Lifelong Dietary Changes – Similarly, gastric sleeve has very few dietary restrictions because the digestive process is the same. The stomach removal can cause some food sensitivities, but generally there are fewer foods that you cannot eat or vitamin deficiencies. But by reducing the amount of time food has to digest, the duodenal switch can lead to severe malnutrition without regular dietary supplements. You will also have to agree to lifelong blood tests to prevent any vitamin or mineral deficiencies.

Overall, duodenal switch has a greater success rate than gastric sleeve. It is considered the preferred option for severely obese patients that require immediate, rapid weight loss intervention.

However, gastric sleeve provides most of the same weight loss benefits with fewer complications and fewer long term follow ups and risk. For most patients, the gastric sleeve is a preferable choice as it can be converted to the duodenal switch if it proves ineffective. But some surgeons may recommend the duodenal switch, particularly for high risk patients.